Changes And Significance Of Serum Claudin-4 Levels In Patients With Sepsis

Objective The present study was designed to investigate the changes and significance of serum claudin- 4 levels in patients with sepsis.Materials and methods This prospective study was conducted in the intensive care unit(ICU) of the General Hospital of Ning Xia Medical University.From June 2015 to December 2015, 84 patients(>18 years old) who fulfilled the criteria for sepsis as defined by the American College of Chest Phsicians/Society of Critical Care Medicine(ACCP/SCCM)were enrolled.Patients were divided into the following groups:systemic inflammatory response syndrome(SIRS, 21 cases), sepsis(24 cases), severe sepsis(19 cases), septic shock(20 cases).Choose At the same time,22 age-matched healthy physical examination individuals were enrolled as controls. For all patients the following operations were need on admission in the first 24 hours: to detect the concentration of procalcitonin, to calculate the Acute Physiology and Chronic Health Evaluation(APACHE) II score and the sequential organ failure assessment(SOFA),to obtain venous blood for detecting serum claudin-4 levels with enzyme-linked immunosorbent assay(ELISA).Related laboratory results on ICU arrival were documented. To predict the clinica outcomes in patients with sepsis,serum claudin-4 levels in non-survivors and survivors were compared with two sets of independent sample t test,as MODS and.non-MODS.Spearman correlation analysis were used to access correlation between claudin-4 levels with APACHE II score,SOFAscore,PCT levels,Lactate levels.To compare the predictive value of claudin-4,APACHEII score,PCT,SOFA score,laccte for sepsis,receiver operating characteristic(ROC) cures were constructed and the areas under the ROC curves(AUCs) were determined.Results The main findings of the presented study were that serum claudin-4 were higher in patients with sepsis than controls,were positively associated with the disease severity with sepsis and statistically significant in all groups(P< 0.05).Two sets of independent sample t test indicates: serum claudin-4 levels were elevated in non-survivors compared with survivors(P<0.01).In addition,compared with the non-MODS groups,the concentrations of claudin-4 were significantly higher in patients with MODS.Refering to correlation analysis,the claudin-4 levels were positively correlated with APACHE II score as well as SOFA score and lactate levels(r1=0.57, r2=0.51,r3=0.54,均 P<0.01).The areas under the ROC curves(AUCs) were 0.879,and the cutoff value for claudin-4 to diagnose sepsis was 67.6pg/ml.Using this cutoff value,the sensitivity,specificity,posititve predictive value(PPV),and negative predictive value(NPV) were 69.8%,90.5%,95.0%,48.7%,respectively.Conclusions Serum claudin-4 levels can reflect disease severity with sepsis and appear to be a early prognostic mark in patients suffering from sepsis.